Six Key Moments: Path to Consensus Series, Surprise Billing and Utilization Challenges

WASHINGTON-Rising healthcare costs and system inefficiencies continue to place significant strain on both patients and providers nationwide. During the third installment of U.S. Congressman Aaron Bean's (FL-04) Path to Consensus Series on surprise billing and prior authorization delays, expert panelists highlighted what's working, what's not, and why payment disputes still clog the system.

KEY MOMENT #1: Patients Have Been Removed from the Middle of Surprise Billing Disputes

Garrett Hohimer, Vice President of Policy and Advocacy, Business Group on Health: "The clearest win here has been on behalf of patients and taking them out of the middle. We are elated with the development of the No Surprises Act to really take patients out of the middle there."

KEY MOMENT #2: Arbitration Was Intended to Encourage Negotiation - Not Replace It

Patrick Velliky, Chief External Affairs Officer, HaloMD: "The IDR process is expensive and cumbersome on purpose. That is a feature, not a bug, because it is supposed to be more painful to go through arbitration for either party than it is to simply reach an in-network arrangement."

KEY MOMENT #3: Elective Procedures Are Driving High-Dollar Arbitration Awards

Ariel Bayewitz, Vice President, Health Economics, Elevance Health: "The majority of award dollars actually is going to elective and planned procedures. On average, we are seeing awards over eight times what we pay in-network physicians."

KEY MOMENT #4: Administrative Costs and IDR Fees Need Reform

Dr. Adam Bruggeman, Chairman, IndeMed: "It should be easier to pick up the phone and call and say, 'Hey, let's come up with a fair price and figure this out before we all have to spend a bunch of money.'"

KEY MOMENT #5: Prior Authorization Delays Are Affecting Patient Care

Mary Mayhew, President and CEO, Florida Hospital Association: "We have a moral imperative. These are human beings. The care that they need cannot wait."

KEY MOMENT #6: Prior Authorization Remains an Important Safeguard Against Fraud and Rising Costs

Jeanette Thornton, Executive Vice President of Policy & Strategy, America's Health Insurance Plans: "The vast majority of claims aren't subject to prior authorization. It is a really important clinical safeguard."

To watch the Path to Consensus Series in its entirety, CLICK HERE.

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